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PRACTICE STORY/OPINION
Year : 2020  |  Volume : 18  |  Issue : 4  |  Page : 334-337

Fighting coronavirus in a far and forgotten corner of India: Formidable challenges faced in a remote mission hospital


Shanti Bhavan Medical Centre, Simdega, Jharkhand, India

Date of Submission18-Jul-2020
Date of Decision19-Jul-2020
Date of Acceptance04-Aug-2020
Date of Web Publication19-Oct-2020

Correspondence Address:
Dr. George Mathew
Shanti Bhavan Medical Centre, Simdega, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_115_20

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How to cite this article:
Mathew G. Fighting coronavirus in a far and forgotten corner of India: Formidable challenges faced in a remote mission hospital. Curr Med Issues 2020;18:334-7

How to cite this URL:
Mathew G. Fighting coronavirus in a far and forgotten corner of India: Formidable challenges faced in a remote mission hospital. Curr Med Issues [serial online] 2020 [cited 2020 Nov 26];18:334-7. Available from: https://www.cmijournal.org/text.asp?2020/18/4/334/298583



When the news of COVID-19 Infection reaching the shores of Kerala arrived in Biru, in a small remote village in Jharkhand, it did not worry us because we assumed that our isolation and distance from any city will protect us. We were convinced that the virus will not travel to such a remote region where we worked.

How wrong we were!!!!

Very soon, our lives in a small Christian hospital were going to be irreversibly turned upside down. Soon, the infections reached Ranchi, the nearest city about 130 Kilometers away, and then it hit us in Simdega, a very remote as well as the poorest district of Jharkhand.

Shanti Bhavan Hospital is a small secondary-level Christian hospital situated in a predominantly tribal area of Jharkhand in a village called Biru within Simdega, the most backward district of Jharkhand. This hospital is located almost in the middle of nowhere about 130 Kilometers from Ranchi and 100 Kilometers from Rourkela, which are the nearest cities connected only by road. All supplies and drugs have to come from one of these places.

Surrounding the hospital are small hamlets which are predominantly inhabited by tribals. Their main occupation is marginal farming apart from collecting forest products, and agricultural activity is carried on only during the rainy season. When there is no cultivation, the men mostly migrate to the nearby states for manual laborers, leaving behind the elderly, children, and women. Hence, this hospital exists among a much-marginalized population. Alcoholism is rampant irrespective of age and sex and added to this is a high illiteracy rate. People are so poor, that often they are unable to afford even the minimum cost of treatment. This Sixty bed facility is well equipped but grossly understaffed [Figure 1].
Figure 1: An Ariel view of the isolated hospital.

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I lead a team of four doctors: two senior doctors including me who is almost 70 years old and two young doctors fresh out of college.

We are the only secondary-level hospital in a radius of 70–80 Kilometers and for some facility such as intensive care unit (ICU), there is none for 100 Kilometers. The nearest bigger centers are in Ranchi and Rourkela, which are more than 100 km away and takes a minimum of 3–4 Hours by road.

We have to deal with a wide range of emergencies such as snake bites, poisoning, to acute Myocardial infarction and cerebral malaria. We also have to manage all trauma including head injury polytrauma, and penetrating injuries due to knife attacks. For me, it was an acute and very steep relearning curve as I suddenly found myself as a general physician, part orthopedician, an occasional pediatrician, and a gynecologist. I spent short stints at CMC Vellore relearning, endoscopy, and brushing up ICU management as well as radiology including basic ultrasonography.

I managed all these with the intermittent help of CMC specialists who are mostly my students and juniors who came and helped at their own expense and generated funds as well as attracted more patients. On a good day, we had eighty outpatients and 40–45 inpatients. I am grateful to the CMC administration, which was benevolent to allow Faculty and Trainees to help this Christian hospital although it was an outlier in CMC's circle of primary interest.

When I got the government order toward the end of March that we are to be the sole designated COVID hospital for the whole district of Simdega, I felt a sinking feeling in the pit of the stomach [Figure 2].
Figure 2: Covid designated facility.

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My first reaction was panic. How do we manage all the resources needed? What facilities have to be prepared? What about the safety of our staff, most of them including me who is almost 70 and others in their 40-50s.

I had just about managed to get protocols Regarding management of COVID 19 because of being cut off from the mainstream medical community. All the while, the news and social media were full of doom and gloom concentrating more on the horrors that this invisible and vicious virus caused.

There was fear already created in the minds of all our staff because they had heard of all the terrible effects of this deadly virus, and feared its worst possible effects on them and their families.

There was a nationwide full lockdown in place; no shops, no supplies, or transport. Everything had become difficult for Materials and medical supplies.

It looked as though we were about to start a walk through a dark tunnel without knowing where it would lead us. This was undoubtedly the biggest challenge that I had faced.

However, there was hardly any time to think we had to get ready on the run. We had no personal protective equipment (PPE), and these were unavailable anywhere nearby. We had no Specific medicines and our suppliers were closed or out of Stock. So it was like walking into the battle with nothing on us to protect us or nothing in our hands to fight.

We ran helter-skelter to make PPEs ready; there was none available in the state, not even basic medicines such as hydroxychloroquine (HCQ) specific for COVID-19. In spite of all these, the staffs were stoic and heartily cooperated. We borrowed money and took material on credit and made our own PPE. We bought bleaching powder and made hypochlorite solution, we collected industrial spirit for hand sanitizer, and everything we thought collectively was necessary, we improvised [Figure 3] and [Figure 4].
Figure 3: Making of PPEs by our own staff.

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Figure 4: Locally made PPEs.

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We sourced whatever material from the local shops and designed our own PPE and stitched protective gear with everyone pitching in. We made our own four-layered masks as readymade masks were unavailable or prohibitively expensive. We converted plastic sheets into aprons and gumboots for protective footwear.

Then started a cascade of problems which we had not dreamed of.

The foremost was that as a COVID hospital we could not treat or admit any non-COVID patient and so the biggest challenge was that our source of income vanished, As a designated Covid hospital we were advised not to treat any non- covid patients. As a strict lockdown was in place, there was no means of transport for patients to come even for urgent consultation. Our reserves dried up, and we were reduced to a hand-to-mouth daily existence, always anxious where the next day's means to survive will come from.

Added to this was the enormous social stigma attached being a corona hospital. Many of our staff who came from the nearby hamlets were prevented from coming for work saying that they will carry the virus back. They were banned from bathing in the village pond or go near any well, and they were told not to go near the church or the local shops. Many of them were threatened with violence if they persisted in coming to work at the hospital. The stigma of COVID is so profound in the community that our staff were almost outcast in their villages, the intervention by the local police did not have much effect, so we took them all into the hospital and gave them temporary accommodation as well as food. This drove us deeper into debt as we borrowed and took supplies on credit.

But, my growing up in CMC Vellore and the example set by my beloved teachers had taught me that everything starts with prayer. We started each day as we prepared for this task with praying together morning and evening pleading with God to lead us. We held hands with each other promising to look after each other and even if we fell ill because of the virus, we promised to take care of one another. Slowly a conviction that we can do things with God's help permeated this small community in spite of the apparent insurmountable problems confronting us.

We started with whatever we had and soon the patients started arriving. We began with the firm trust that God was with us through this troubled journey. We felt bound to God and each other as continued to care for the COVID-infected patients. We never failed to meet every day to pray and to uphold each other. By God's grace, we were able to source HCQ from the government supplies at last.

We were aware that the state of Jharkhand was facing the enormous influx of migrant laborers from many of the states, and we feared that the flood of cases was on its way. Our fears were proved right when many among these returning laborers were found to be infected. They soon started arriving at our doorsteps; men, pregnant women, and even children. They arrived exhausted, dehydrated, and starving at times. Each of them had a harrowing story of unimaginable travails on the way. They arrived with nothing but what was on their back, not much material possessions to talk of, no money, or any documents. After all these, being infected with COVID was the pinnacle of their misery.

What started as a trickle becomes a flood of COVID and at times we had forty COVID-positive patients in the ward including pregnant women and a 3-year-old child. All of them had to be fed and cared for.

In spite of all the challenges, we treated them with care and compassion without compromising the safety of the staff. We made sure that they were fed nourishing food and had restful time. It was very evident that they could not easily forget the trauma of their travails. We were most anxious about the pregnant women and the children. We were only few doctors and nurses but we worked round the clock despite our fears of safety and physical exhaustion. It was a daunting task for a small community like ours.

It was difficult to convince a 3-year-old child that she cannot move out of the confines of her room? For many of them, especially children, it must have been a frightening experience of the strict isolation and facing medical workers all in strange gear where they could not even clearly see the face or expression of the person taking care of them.

At one point, we thought we had reached the end of our Human resource and our resolve. We were stretched to the limit for money, material, and human power. I was not proud to be in this state and was extremely distressed to expect staff to put their lives in danger without being able to pay them a minimum wage. I had no pride left in me to pretend that we could manage on our own. We prayed hard that God would find a way that we could continue walking faithfully serving Him in spite of the seemingly insurmountable odds.

This is when many of my teachers, classmates, alumni former colleagues, and students appeared on the scene just at the right time with their offers of support. Through my teachers, my classmates, my students, and alumni connections opened many doors of generosity, beyond my wildest dreams.

This was like refreshing showers on a parched land. What started as a trickle soon became a stream of blessing. This brought with it gifts of money for payments of materials such as PPE, medicines, and supplies as well as expenses for food for all of us. These ensured us of our safety and provision for our immediate needs. I could sleep easily after spending sleepless nights, worrying how to meet the needs of the next day.

I owe a deep debt of gratitude to my alma mater, my teachers, alumni, classmates, colleagues' students, and the lasting friendship that I was able to develop in CMC Vellore.

We were able to continue our work with renewed vigor and vitality. At one point, we had 41 COVID-positive patients out of the total fifty COVID beds that we have. We are situated far from any major center for referral, and so we threw everything we could get in our hands in the form of treatment at this menacing virus which we had and we could afford.

So far, we have treated 143 COVID-positive patients. All became negative and were discharged home. There has been no mortality. All our staff are safe, and none have been infected. All these were possible only by God's grace as well as the goodness and support of so many connected with CMC Vellore, my alma mater.

The fight is far from over, and the battle continues. But, today, I am confident that we are not alone in a far, forgotten corner of India waging a lonely struggle against this unseen enemy. So many people connected to CMC have been a part of this difficult journey of this small Christian hospital and the small team, in a distant corner of India.

Now, as the intense anxiety and frantic activity settles to a more manageable phase, the anxiety-filled past few months are fresh in memory. But, I intermittently picture the placid younger days in CMC. As I do, I see the image of evening worship at the college chapel which is permanently etched in my mind and can faintly hear the strains of Aunt Ida's favorite hymn:

Be thou my vision O lord of my heart

Not be all else to me save that thou art

Thou my best thought by day or by night

Waking or sleeping

Thy presence my light.

I owe the little that I am able to do in this distant tribal outpost of India due to the nurture and empowering spirit instilled in my heart by my teachers, and my alma mater which has embodied the motto.

Not to be ministered unto

But to minister.

Three cheers for the silver and blue and the ever-glowing star of Vellore. May this star continue to guide myriads of future generations to commit their lives for the service to humanity above self.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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